40 results found
Masouros SD, Newell N, Ramasamy A, et al., 2013, Design of a Traumatic Injury Simulator for Assessing Lower Limb Response to High Loading Rates, ANNALS OF BIOMEDICAL ENGINEERING, Vol: 41, Pages: 1957-1967, ISSN: 0090-6964
BACKGROUND: Improvements in protection and medical treatments have resulted in increasing numbers of modern-warfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern of injury and determine which factors are associated with a poor clinical outcome. METHODS: U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms. RESULTS: Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors of amputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury, and only nine (14%) of the service members were fit to return to their preinjury duties. CONCLUSIONS: This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rate and frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population.
Ramasamy MA, Hill AM, Phillip R, et al., 2013, FASS is a Better Predictor of Poor Outcome in Lower Limb Blast Injury Than AIS: Implications for Blast Research, JOURNAL OF ORTHOPAEDIC TRAUMA, Vol: 27, Pages: 49-55, ISSN: 0890-5339
Newell N, Masouros SD, Ramasamy A, et al., 2012, Use of cadavers and anthropometric test devices (ATDs) for assessing lower limb injury outcome from under-vehicle explosions, 2012 IRCOBI Conference Proceedings - International Research Council on the Biomechanics of Injury, Pages: 296-303
Lower extremities are particularly susceptible to injury in an under-vehicle explosion. Operational fitness of military vehicles is assessed through anthropometric test devices (ATDs) in full-scale blast tests. The aim of this study was to compare the response between the Hybrid-III ATD, the MiL-Lx ATD and cadavers in our traumatic injury simulator, which is able to replicate the response of the vehicle floor in an under-vehicle explosion. All specimens were fitted with a combat boot and tested on our traumatic injury simulator in a seated position. The load recorded in the ATDs was above the tolerance levels recommended by NATO in all tests; no injuries were observed in any of the 3 cadaveric specimens. The Hybrid-III produced higher peak forces than the MiL-Lx. The time to peak strain in the calcaneus of the cadavers was similar to the time to peak force in the ATDs. Maximum compression of the sole of the combat boot was similar for cadavers and MiL-Lx, but significantly greater for the Hybrid-III. These results suggest that the MiL-Lx has a more biofidelic response to under-vehicle explosive events compared to the Hybrid-III. Therefore, it is recommended that mitigation strategies are assessed using the MiL-Lx surrogate and not the Hybrid-III.
Masouros SD, Newell N, Bonner TJ, et al., 2012, A standing vehicle occupant is likely to sustain a more severe injury than one who has flexed knees in an under-vehicle explosion: A cadaveric study, 2012 IRCOBI Conference Proceedings - International Research Council on the Biomechanics of Injury, Pages: 289-295
The lower limb of military vehicle occupants has been the most injured body part due to undervehicle explosions in recent conflicts. Understanding the injury mechanism and causality of injury severity could aid in developing better protection. Therefore, we tested 4 different occupant postures (seated, brace, standing, standing with knee locked in hyper-extension) in a simulated under-vehicle explosion (solid blast) using our traumatic injury simulator in the laboratory; we hypothesised that occupant posture would affect injury severity. No skeletal injury was observed in the specimens in seated and braced postures. Severe, impairing injuries were observed in the foot of standing and hyper-extended specimens. These results demonstrate that a vehicle occupant whose posture at the time of the attack incorporates knee flexion is more likely to be protected against severe skeletal injury to the lower leg.
Ramasamy A, Hill AM, Phillip R, et al., 2011, The Modern "Deck-Slap" Injury-Calcaneal Blast Fractures From Vehicle Explosions, JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, Vol: 71, Pages: 1694-1698, ISSN: 0022-5282
Thakur B, Shalhoub J, Hill AM, et al., 2011, Heterogeneity of reporting standards in randomised clinical trials of endovenous interventions for varicose veins, Vasomed, Vol: 23, ISSN: 0942-1181
Ramasamy A, Hill AM, Masouros SD, et al., 2011, Evaluating the effect of vehicle modification in reducing injuries from landmine blasts. An analysis of 2212 incidents and its application for humanitarian purposes, ACCIDENT ANALYSIS AND PREVENTION, Vol: 43, Pages: 1878-1886, ISSN: 0001-4575
Hill AM, Shalhoub J, 2011, Teaching of anatomy through cadaveric dissection: are we really satisfied?, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 72, Pages: 535-535, ISSN: 1750-8460
Hill AM, Shalhoub J, 2011, Widening access to medicine, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 72, Pages: 474-474, ISSN: 1750-8460
Ramasamy A, Hill AM, Masouros S, et al., 2011, Blast-related fracture patterns: a forensic biomechanical approach, JOURNAL OF THE ROYAL SOCIETY INTERFACE, Vol: 8, Pages: 689-698, ISSN: 1742-5689
Briffa N, Pearce R, Hill AM, et al., 2011, Outcomes of acetabular fracture fixation with ten years' follow-up, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 93B, Pages: 229-236, ISSN: 0301-620X
Ramasamy A, Masouros SD, Newell N, et al., 2011, In-vehicle extremity injuries from improvised explosive devices: current and future foci, PHILOSOPHICAL TRANSACTIONS OF THE ROYAL SOCIETY B-BIOLOGICAL SCIENCES, Vol: 366, Pages: 160-170, ISSN: 0962-8436
Shalhoub J, Hill AM, Davies AH, 2011, Beware the commodification of medical education?, MEDICAL TEACHER, Vol: 33, Pages: 863-863, ISSN: 0142-159X
Brown K, Bo C, Ramasamy A, et al., 2011, Prospects for studying how high-intensity compression waves cause damage in human blast injuries, 17th Biennial International Conference of the American Physical Society: Topical Group on Shock Compression of Condensed Matter
Thakur B, Shalhoub J, Hill AM, et al., 2010, Heterogeneity of Reporting Standards in Randomised Clinical Trials of Endovenous Interventions for Varicose Veins, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 40, Pages: 528-533, ISSN: 1078-5884
Ramasamy A, Hill AM, Gibb I, et al., 2010, Explosion mediated fracture patterns relate to environment: a forensic biomechanical approach, Annual Meeting of the British Orthopaedic Research Society
Ramasamy A, Hill AM, Clasper JC, 2009, Improvised explosive devices: pathophysiology, injury profiles and current medical management., J R Army Med Corps, Vol: 155, Pages: 265-272, ISSN: 0035-8665
The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.
Ramasamy A, Hill AM, Hepper AE, et al., 2009, Blast mines: physics, injury mechanisms and vehicle protection., J R Army Med Corps, Vol: 155, Pages: 258-264, ISSN: 0035-8665
Since World War II, more vehicles have been lost to land mines than all other threats combined. Anti-vehicular (AV) mines are capable of disabling a heavy vehicle, or completely destroying a lighter vehicle. The most common form of AV mine is the blast mine, which uses a large amount of explosive to directly damage the target. In a conventional military setting, landmines are used as a defensive force-multiplier and to restrict the movements of the opposing force. They are relatively cheap to purchase and easy to acquire, hence landmines are also potent weapons in the insurgents' armamentarium. The stand-offnature of its design has allowed insurgents to cause significant injuries to security forces in current conflicts with little personal risk. As a result, AV mines and improvised explosive devices (IEDs) have become the most common cause of death and injury to Coalition and local security forces operating in Iraq and Afghanistan. Detonation of an AV mine causes an explosive, exothermic reaction which results in the formation of a shockwave followed by a rapid expansion of gases. The shockwave is mainly reflected by the soillair interface and fractures the soil cap overthe mine. The detonation products then vent through the voids in the soil, resulting in a hollow inverse cone which consists of the detonation gases surrounded by the soil ejecta. It is the combination of the detonation products and soil ejecta that interact with the target vehicle and cause injury to the vehicle occupants. A number of different strategies are required to mitigate the blast effects of an explosion. Primary blast effects can be reduced by increasing the standoff distance between the seat of the explosion and the crew compartment. Enhancement of armour on the base of the vehicle, as well as improvements in personal protection can prevent penetration of fragments. Mitigating tertiary effects can be achieved by altering the vehicle geometry and structure, increasing vehicle mass, as well
Smith CD, Masouros S, Hill AM, et al., 2009, A biomechanical basis for tears of the human acetabular labrum, BRITISH JOURNAL OF SPORTS MEDICINE, Vol: 43, Pages: 574-578, ISSN: 0306-3674
Southgate DF, Hill AM, Alexander S, et al., 2009, The range of axial rotation of the glenohumeral joint., J Biomech, Vol: 42, Pages: 1307-1312, ISSN: 1873-2380
There is a paucity of data in the literature on the restraining effects of the glenohumeral (GH) ligaments; cadaveric testing is one of the best methods for determining the function of these types of tissues. The aim of this work was to commission a custom-made six degrees of freedom (dof) joint loading apparatus and to establish a protocol for laxity testing of cadaveric shoulder specimens. Nine cadaveric shoulder specimens were used in this study and each specimen had all muscle resected leaving the scapula, humerus (transected at mid-shaft) and GH capsule. Specimens were mounted on the testing apparatus with the joint in the neutral position and at 30 degrees, 60 degrees and 90 degrees GH abduction in the coronal, scapula and 30 degrees forward flexion planes. For each orientation, 0-1 N m in 0.1 N m increments was applied in internal/external rotation and the angular displacement recorded. The toe-region of the moment-displacement curves ended at approximately +/-0.5 N m. The highest rotational range of motion for the joint was 140 degrees for +/-1.0 N m at 30 degrees GH abduction in the scapula plane. The range of motion shifted towards external rotation with increasing levels of abduction. The results provide the optimum loading regime to pre-condition shoulder specimens and minimise viscoelastic effects in the ligaments prior to laxity testing (>0.5 N m at 30 degrees GH abduction in any of the three planes). Knowledge of the mechanical properties of the GH capsuloligamentous complex has implications for modelling of the shoulder as well surgical planning and intervention.
Smith CD, Masouros SD, Hill AM, et al., 2009, The Compressive Behavior of the Human Glenoid Labrum May Explain the Common Patterns of SLAP Lesions, ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, Vol: 25, Pages: 504-509, ISSN: 0749-8063
Masouros SD, Parker KH, Hill AM, et al., 2009, Testing and modelling of soft connective tissues of joints: a review, Journal of Strain Analysis for Engineering Design, Vol: 44, Pages: 305-318
There is wealth of data from experimental and numerical methods of analysing and modelling soft connective tissues of joints. In recent years, the advances in computational and technological capabilities allowed for several aspects of the function and mechanical behaviour of soft connective tissues of joints to be explored. However, the nature of soft tissue poses a great challenge in characterising its material behaviour in a repeatable and physiologically or clinically relevant manner. This review article attempts to present, critique and suggest experimental and numerical methods that are associated with the function and mechanical response of soft connective tissues of joints.
Smith CD, Masouros S, Hill AM, et al., 2008, Mechanical testing of intra-articular tissues. Relating experiments to physiological function, CURRENT ORTHOPAEDICS, Vol: 22, Pages: 341-348, ISSN: 0268-0890
Hill AM, Hoerning EJ, Brook K, et al., 2008, Collagenous microstructure of the glenoid labrum and biceps anchor., J Anat, Vol: 212, Pages: 853-862, ISSN: 1469-7580
The glenoid labrum is a significant passive stabilizer of the shoulder joint. However, its microstructural form remains largely unappreciated, particularly in the context of its variety of functions. The focus of labral microscopy has often been histology and, as such, there is very little appreciation of collagen composition and arrangement of the labrum, and hence the micromechanics of the structure. On transmission electron microscopy, significant differences in diameter, area and perimeter were noted in the two gross histological groups of collagen fibril visualized; this suggests a heterogeneous collagenous composition with potentially distinct mechanical function. Scanning electron microscopy demonstrated three distinct zones of interest: a superficial mesh, a dense circumferential braided core potentially able to accommodate hoop stresses, and a loosely packed peri-core zone. Confocal microscopy revealed an articular surface fine fibrillar mesh potentially able to reduce surface friction, bundles of circumferential encapsulated fibres in the bulk of the tissue, and bone anchoring fibres at the osseous interface. Varying microstructure throughout the depth of the labrum suggests a role in accommodating different types of loading. An understanding of the labral microstructure can lead to development of hypotheses based upon an appreciation of this component of material property. This may aid an educated approach to surgical timing and repair.
Hill AM, Bull AMJ, Wallace AL, et al., 2008, Qualitative and quantitative descriptions of glenohumeral motion, GAIT & POSTURE, Vol: 27, Pages: 177-188, ISSN: 0966-6362
Hill AM, Bull AMJ, Richardson J, et al., 2008, The clinical assessment and classification of shoulder instability, Current Orthop, Vol: 22, Pages: 208-225
Hill AM, Bull AMJ, Dallalana RJ, et al., 2007, Glenohumeral motion: review of measurement techniques, KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 15, Pages: 1137-1143, ISSN: 0942-2056
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